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目的：探讨拉米夫定对乙型肝炎病人抗病毒效果及ＹＭＤＤ变异株的发生情况。方法：观察拉米夫定治疗前及治疗后３个月、６个月、９个月肝功能（ＡＬＴ）及免疫学指标的变化，并采用ＰＣＲ微板核酸杂交ＥＬＩＳＡ技术检测 ＨＢＶ ＤＮＡ含旦及ＹＭＤＤ变异株（包括 ＹＩＤＤ及 ＹＶＤＤ突变株）。结果：４７例 ＨＢＶ ＤＮＡ阳性的乙肝病人口服拉米夫定治疗 ９个月后 ７４％的病人血清 ＨＢＶＤＮＡ水平转阴（＜１ｐｇ／ｍｌ血清），伴有ＡＬＴ水平正常。有１７％的病人出现 ＨＢｅＡｇ血清转移（ｅ抗原转阴，ｅ抗体转阳）。另有１５％病人单纯ＨＢｅＡｇ阳转阴。共有１９％的病人出现ＹＭＤＤ变异株，分别于服药前３个月后１例，服药６个月后３例，服药９个月后又５例。其中有３例病人在服药期间出现ＹＭＤＤ耐药株，经加大拉米夫定用药３个月后，ＹＭＤＤ耐药株消失。仅１例病人加大用药剂量后耐药株不消失。结论：口服拉米夫定 ９个月，大多数病人血清 ＨＢＶ ＤＮＡ转阴（＜１ｐｇ／ｍｌ），１７％部分病人出现ｅ抗原血清转移；１９％的病人出现 ＹＭＤＤ耐药。而ｅ抗原血清转移绝大多数发生于 ＨＢＶ ＤＮＡ低于 １００ｐｇ／ｍｌ血清的病人。
Objective: To investigate the antiviral effect of lamivudine on hepatitis B patients and the occurrence of YMDD mutant strains. Methods: The changes of liver function (ALT) and immunological indexes of lamivudine before treatment, 3 months, 6 months and 9 months after treatment were observed. The DNA microarray YMDD variants (including YIDD and YVDD mutants). Results: Serum HBVDNA level was negative (<1pg / ml serum) in 74 HBV-positive hepatitis B patients after oral lamivudine treatment for 9 months, with normal ALT levels. In 17% of patients HBeAg seroconversion (e antigen negative, e antibody positive). Another 15% of patients simply HBeAg positive yin. A total of 19% of the patients had YMDD mutation strains, 1 case 3 months after taking the medicine, 3 cases 6 months after taking the medicine and 5 cases 9 months after taking the medicine. YMDD-resistant strains were found in 3 patients during the treatment period. After 3 months of intensive lamivudine treatment, YMDD-resistant strains disappeared. Only one case of patients to increase the dose after the drug-resistant strains do not disappear. Conclusions: Serum HBV DNA was negative (<1 pg / ml) in most patients at 9 months after oral lamivudine treatment. Serum e antigen was transferred in 17% of patients and YMDD resistance in 19% of patients. The vast majority of e antigen serum transfer occurred in patients with HBV DNA less than 100pg / ml serum.